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Role of C-arm cone-beam CT in chemoembolization for hepatocellular carcinoma.

Kim HC - Korean J Radiol (2015)

Bottom Line: With the advent of C-arm cone-beam computed tomography (CBCT), minimally-invasive procedures in the angiography suite made a new leap beyond the limitations of 2-dimensional (D) angiography alone.C-arm CBCT can help interventional radiologists in several ways with the treatment of hepatocellular carcinoma (HCC); visualization of small tumors and tumor-feeding arteries, identification of occult lesion and 3D configuration of tortuous hepatic arteries, assurance of completeness of chemoembolization, suggestion of presence of extrahepatic collateral arteries supplying HCCs, and prevention of nontarget embolization.With more improvements in the technology, C-arm CBCT may be essential in all kinds of interventional procedures in the near future.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Seoul National University College of Medicine, Institute of Radiation Medicine, Seoul National University Medical Research Center, and Clinical Research Institute, Seoul National University Hospital, Seoul 110-744, Korea.

ABSTRACT
With the advent of C-arm cone-beam computed tomography (CBCT), minimally-invasive procedures in the angiography suite made a new leap beyond the limitations of 2-dimensional (D) angiography alone. C-arm CBCT can help interventional radiologists in several ways with the treatment of hepatocellular carcinoma (HCC); visualization of small tumors and tumor-feeding arteries, identification of occult lesion and 3D configuration of tortuous hepatic arteries, assurance of completeness of chemoembolization, suggestion of presence of extrahepatic collateral arteries supplying HCCs, and prevention of nontarget embolization. With more improvements in the technology, C-arm CBCT may be essential in all kinds of interventional procedures in the near future.

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47-year-old man with hepatocellular carcinoma and Child-Pugh C class disease.A. Axial CT scan shows exophytic enhancing nodule (arrowhead) in gallbladder bed. B. Celiac angiography shows tumor staining (arrowhead). C. Volume-rendering image of C-arm cone-beam CT with left anterior oblique projection of 30 degree shows tumor-feeding artery from S5 hepatic artery (arrowheads). D. Volume-rendering image of C-arm cone-beam CT with right anterior oblique projection of 20 degree and cranial oblique projection of 15 degree shows tumor-feeding artery from deep cystic artery (arrowhead). E. Spot image during chemoembolization shows tip (arrowhead) of microcatheter advanced into S5 hepatic artery. F. Spot image during chemoembolization shows tip (arrowhead) of microcatheter advanced into deep cystic artery.
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Figure 4: 47-year-old man with hepatocellular carcinoma and Child-Pugh C class disease.A. Axial CT scan shows exophytic enhancing nodule (arrowhead) in gallbladder bed. B. Celiac angiography shows tumor staining (arrowhead). C. Volume-rendering image of C-arm cone-beam CT with left anterior oblique projection of 30 degree shows tumor-feeding artery from S5 hepatic artery (arrowheads). D. Volume-rendering image of C-arm cone-beam CT with right anterior oblique projection of 20 degree and cranial oblique projection of 15 degree shows tumor-feeding artery from deep cystic artery (arrowhead). E. Spot image during chemoembolization shows tip (arrowhead) of microcatheter advanced into S5 hepatic artery. F. Spot image during chemoembolization shows tip (arrowhead) of microcatheter advanced into deep cystic artery.

Mentions: C-arm CBCT can identify tumor-feeding arteries better than digital subtraction angiography (DSA) (Fig. 4). Meyer et al. (19) reported that the number of vessels identified as tumor feeders in each patient was significantly higher using additional C-arm CBCT than on angiography alone (4.0 ± 1.7 vs. 3.3 ± 1.4; p = 0.003). Iwazawa et al. (20) reported that the sensitivity, specificity, and accuracy of C-arm CBCT concerning identification of tumor-feeding arteries (96.9%, 97.0%, and 96.9%, respectively) were significantly higher than those for DSA (77.2%, 73.0%, and 75.4%, respectively).


Role of C-arm cone-beam CT in chemoembolization for hepatocellular carcinoma.

Kim HC - Korean J Radiol (2015)

47-year-old man with hepatocellular carcinoma and Child-Pugh C class disease.A. Axial CT scan shows exophytic enhancing nodule (arrowhead) in gallbladder bed. B. Celiac angiography shows tumor staining (arrowhead). C. Volume-rendering image of C-arm cone-beam CT with left anterior oblique projection of 30 degree shows tumor-feeding artery from S5 hepatic artery (arrowheads). D. Volume-rendering image of C-arm cone-beam CT with right anterior oblique projection of 20 degree and cranial oblique projection of 15 degree shows tumor-feeding artery from deep cystic artery (arrowhead). E. Spot image during chemoembolization shows tip (arrowhead) of microcatheter advanced into S5 hepatic artery. F. Spot image during chemoembolization shows tip (arrowhead) of microcatheter advanced into deep cystic artery.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4296258&req=5

Figure 4: 47-year-old man with hepatocellular carcinoma and Child-Pugh C class disease.A. Axial CT scan shows exophytic enhancing nodule (arrowhead) in gallbladder bed. B. Celiac angiography shows tumor staining (arrowhead). C. Volume-rendering image of C-arm cone-beam CT with left anterior oblique projection of 30 degree shows tumor-feeding artery from S5 hepatic artery (arrowheads). D. Volume-rendering image of C-arm cone-beam CT with right anterior oblique projection of 20 degree and cranial oblique projection of 15 degree shows tumor-feeding artery from deep cystic artery (arrowhead). E. Spot image during chemoembolization shows tip (arrowhead) of microcatheter advanced into S5 hepatic artery. F. Spot image during chemoembolization shows tip (arrowhead) of microcatheter advanced into deep cystic artery.
Mentions: C-arm CBCT can identify tumor-feeding arteries better than digital subtraction angiography (DSA) (Fig. 4). Meyer et al. (19) reported that the number of vessels identified as tumor feeders in each patient was significantly higher using additional C-arm CBCT than on angiography alone (4.0 ± 1.7 vs. 3.3 ± 1.4; p = 0.003). Iwazawa et al. (20) reported that the sensitivity, specificity, and accuracy of C-arm CBCT concerning identification of tumor-feeding arteries (96.9%, 97.0%, and 96.9%, respectively) were significantly higher than those for DSA (77.2%, 73.0%, and 75.4%, respectively).

Bottom Line: With the advent of C-arm cone-beam computed tomography (CBCT), minimally-invasive procedures in the angiography suite made a new leap beyond the limitations of 2-dimensional (D) angiography alone.C-arm CBCT can help interventional radiologists in several ways with the treatment of hepatocellular carcinoma (HCC); visualization of small tumors and tumor-feeding arteries, identification of occult lesion and 3D configuration of tortuous hepatic arteries, assurance of completeness of chemoembolization, suggestion of presence of extrahepatic collateral arteries supplying HCCs, and prevention of nontarget embolization.With more improvements in the technology, C-arm CBCT may be essential in all kinds of interventional procedures in the near future.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Seoul National University College of Medicine, Institute of Radiation Medicine, Seoul National University Medical Research Center, and Clinical Research Institute, Seoul National University Hospital, Seoul 110-744, Korea.

ABSTRACT
With the advent of C-arm cone-beam computed tomography (CBCT), minimally-invasive procedures in the angiography suite made a new leap beyond the limitations of 2-dimensional (D) angiography alone. C-arm CBCT can help interventional radiologists in several ways with the treatment of hepatocellular carcinoma (HCC); visualization of small tumors and tumor-feeding arteries, identification of occult lesion and 3D configuration of tortuous hepatic arteries, assurance of completeness of chemoembolization, suggestion of presence of extrahepatic collateral arteries supplying HCCs, and prevention of nontarget embolization. With more improvements in the technology, C-arm CBCT may be essential in all kinds of interventional procedures in the near future.

Show MeSH
Related in: MedlinePlus